Talamo Laser Eye Consultants

WHAT IS AN OPHTHALMOLOGIST?
An ophthalmologist is a physician (medical doctor) who specializes in the diagnosis, medical, and surgical treatment of the eyes. An ophthalmologist obtains a medical degree and then completes further specialty training in the medical and surgical treatment of eye conditions.

WHAT IS AN OPTOMETRIST?
An optometrist is a doctor of optometry who specializes in the examination, diagnosis, treatment, prevention, and management of diseases and disorders of the visual system.

An optometrist attends a specialized school of optometry for four years, but does not obtain a medical degree and is not required to complete post-graduate clinical training.

WHY SHOULD I COME TO TALAMO LASER EYE CONSULTANTS ?
This is an important decision because we’re talking about your vision. We use the most modern FDA approved lasers, maintain strict sterilization techniques, and make every effort to deliver the highest standard of customer care and service to you during your vision correction experience. Our practice is closely connected to new developments in the field, as Dr. Talamo trains other doctors, is asked to lecture extensively on the subject of refractive surgery, has written textbooks on the subject, and has participated in FDA-sanctioned clinical trials of the new technology.

WHAT ARE THE SPECIAL QUALIFICATIONS OF DR. TALAMO?
Dr. Talamo is board certified by the American Board of Ophthalmology and fellowship-trained in corneal transplant and refractive surgery, which involves an extra 1-2 years of intensive training beyond the required residency that all ophthalmologists must complete. Dr. Talamo has served as the director of corneal specialty division of The Massachusetts Eye and Ear Infirmary and Harvard Medical School. Dr. Talamo has trained hundreds of other surgeons in refractive surgical techniques, and is frequently invited to lecture about refractive surgery all over the world. A highly experienced surgeon, Dr. Talamo has performed over 10,000 laser refractive procedures. He has authored many peer-reviewed publications in the field of refractive surgery as well as numerous book chapters and a textbook on excimer laser surgery (LASIK and PRK).

WHAT IS MYOPIA OR NEARSIGHTEDNESS?
Nearsightedness is a condition where the cornea is curved too much and causes light to focus short of the retina. With nearsightedness you can see objects up close but objects in the distance appear blurry.

WHAT IS HYPEROPIA OR FARSIGHTEDNESS?
Farsightedness is a condition where the cornea is too flat and causes light to focus behind the retina. With farsightedness you see objects clearly in the distance, but close objects appear blurry.

WHAT IS ASTIGMATISM?
The front of the astigmatic eye has an irregular shape, more oval, like a football. Incoming light focuses on multiple points instead of one. Astigmatism can make wearing contact lenses difficult or even impossible. Astigmatism is often combined with nearsightedness or farsightedness, which results in objects at all distances appearing blurry. Since 1996, laser vision correction has been an option for people with astigmatism who want clear, comfortable vision.

WHAT IS PRESBYOPIA?
As people age, the natural lens in their eyes hardens and loses its flexibility, impairing its ability to vary its shape for different ranges and focus. This condition is known as Presbyopia and develops in most people between 40-50 years of age. The need for reading glasses is a very common problem for most people as they enter their middle years.

WHAT IS MONOVISION?
Monovision is one option for dealing with the focusing problems caused by Presbyopia, by correcting one eye for near and the other eye for distance. Other options are using reading glasses or wearing bifocal glasses that can provide both near and far vision.

Monovision can be achieved through corrective lenses or through refractive surgery. One eye can be corrected for distance and the other corrected to provide better close vision. If this option seems desirable, your surgeon may suggest a simulation test during a comprehensive examination, or using contact lenses to achieve the similar effect prior to surgery, to determine your ability to adapt to this situation.

IS LASER VISION CORRECTION SAFE?
Yes. Tens of millions of patients worldwide have had this treatment performed on them successfully. The FDA has approved numerous lasers for correction for nearsightedness, farsightedness, and astigmatism, and found the treatment safe and effective for eligible patients. Although there are risks associated with any surgical procedure, today’s laser vision correction procedures are extremely precise. The more experienced the surgeon is, the more knowledgeable he/she will be about preventing and managing any complications. In addition to having performed thousands of these procedures, our surgeons have trained hundreds of other eye surgeons.

AM I A CANDIDATE?
Dr. Talamo can tell you if vision correction is right for you. Some general guidelines are:

• You must have healthy eyes.

• You must be at least 18 years old.

• Your vision must be stable for at least one year before the laser procedure is done (no significant change in your correction for the previous 12 months).

WHAT WOULD ELIMINATE ME AS A CANDIDATE FOR REFRACTIVE SURGERY?
You are not a good candidate if you have degenerative or autoimmune diseases, or you’re pregnant or nursing, or if you are considering a pregnancy in the coming six months.

CAN PEOPLE “ POSSIBLY” BE A CANDIDATE FOR MORE LASER VISION CORRECTION OR OTHER PROCEDURES SUCH AS INTACS IF THEY PREVIOUSLY HAD RK, PRK OR LASIK?

RK = Possibly, but Dr. Talamo will need to examine you to determine your specific situation.

PRK and Lasik = Probably. Dr. Talamo will need to examine you to determine your specific situation.

CAN KERATOCONUS PATIENTS EVER BE CANDIDATES FOR LASER OR INTACS SURGERY?
Yes, on occasion. You will need to be examined by a cornea specialist such as Dr. Talamo to determine your specific situation.

WHAT IF MY EYES KEEP CHANGING?
Stable vision is a qualification requirement to be a candidate for the Intacs and laser vision correction procedures.

I HAVE WORN CONTACT LENSES FOR YEARS, IS THIS A PROBLEM?
Not usually. Dr. Talamo will ask you to NOT wear contact lenses for two (soft lenses) to four weeks (gas permeable lenses) before any final measurements for a refractive procedure. This allows the cornea to relax back to its original condition and the eye to its most stable prescription. When you come in for a complimentary evaluation, the amount of time for you can be determined.

DOES DRY-EYE CONDITION AFFECT CANDIDACY FOR LASER VISION CORRECTION OR INTACS?
It might. A microscopic exam of the cornea will be needed to determine that (for proper diagnosis?).

DO YOU HAVE FINANCING AVAILABLE?
We do have financing available for refractive surgery. See the link on our home page.

CAN I PAY FOR REFRACTIVE SURGERY USING PRE-TAX DOLLARS?
Many patients pay for their refractive surgery procedure with pre-tax dollars by having the money withheld into a pre-tax flexible spending account. Consult with your human resources department or our office for further information.

DO YOU HAVE ANY OUTCOME STATISTICS?
The present studies evaluating LASIK and PRK show that more than 95% of appropriate candidates can expect to see better than 20/40 without correction, and patients with low corrections have a 95% chance of 20/20 after a single procedure. Our data support these numbers. The chance that a patient will achieve 20/20 uncorrected vision after surgery is directly related to the degree of attempted correction, with accuracy being greater for smaller corrections.

WILL I BE 20/20 AFTER THE PROCEDURE?
While vision correction procedures have been proven overwhelmingly successful in reducing dependence on glasses and contact lenses, the degree of improvement may vary among individuals. How well and how quickly your vision improves depends on how well you heal and the severity of your prescription (level of correction required?). During your complimentary evaluation, Dr. Talamo and his technicians will help determine the range of your probable outcome based on your particular prescription, healing profile and expectations.

Today’s vision correction procedures are extremely accurate and we target your best-corrected vision. The majority of our patients are able to see well enough to function without glasses or contacts at all.

IS LASER VISION CORRECTION PERMANENT?
Laser Vision Correction has been commonly performed in many countries around the world since the late 1980’s. In addition, many clinical studies have looked at the long-term effects of the excimer laser on the cornea. While the long-term effects beyond twelve years have not been studied, every study performed so far has shown that the procedure does not lose its effectiveness over time in most cases.

When you come in for your complimentary evaluation we’ll be happy to go over everything you will need to know and answer all of your questions.

WHAT ARE THE RISKS?
There are risks with any surgical procedure. Advanced technology combined with an experienced surgeon and staff reduces risk, and the vast majority of our patients are extremely satisfied with the results of the surgery.

Infection is the most serious risk. However, Dr. Talamo and his operating room staff maintain the highest standard of cleanliness, and almost all of the instruments used for your surgery are designed for single use and come to our operating room sterilely pre-packaged. The patient also has a responsibility to follow the doctor’s post-operative instructions to prevent infection.

When you come in for your complimentary evaluation the doctor will cover all possible risks and answer all of your questions.

COULD I GO BLIND?
The chance of having a vision reducing complication has been documented in our experience in a number of clinical studies to be a small fraction of 1%, and in those cases the amount of visual reduction was almost always mild or minimal? The skill and years of experience of Dr. Talamo reduces the probability of any risks still further.

When you visit our laser center for your complimentary evaluation, Dr. Talamo will discuss all possible risks and answer all of your questions.

WILL SURGICAL VISION CORRECTION CREATE OR PROMOTE CATARACTS, GLAUCOMA, ETC.?
If you are genetically predisposed to cataracts, glaucoma, etc, vision correction will neither aggravate nor prevent the onset of these eye diseases or conditions.

WHAT ARE SOME COMMON SIDE EFFECTS OF LASER VISION CORRECTION?

• Dry eyes and increased sensitivity to light.

• Halo effect from bright light at night.

• Decreased visual acuity in dim light.

For most patients, these symptoms fade and disappear with time, but could last for months after surgery.

IS LASIK, PRK OR INTACS PAINFUL?
Not usually. For all procedures, you will be given numbing drops just prior to the procedure. You will be awake during the procedure, but this is all right because the treatment is not painful.

After LASIK or INTACS: You may experience a slight sandy or gritty feeling after your procedure. Some patients may take Tylenol or Ibuprofen following surgery, but most do not find this necessary.

After PRK: Intermittent scratchiness, tearing and burning is common for a few days. We prescribe anti-inflammatory drops to help with these symptoms. Stronger pain medication is also prescribed, and about 50% of patients will use it at some point during the first few days.

DO YOU CORRECT BOTH EYES AT THE SAME TIME?
Yes, we can. The recovery time for LASIK and Intacs procedures is very quick; therefore, doing both eyes at the same time is common. After PRK, visual recovery takes longer, but many patients find that they can still function adequately if they reduce their activity a bit and take a few days off of work. The surgeon will be able to help you determine the best way for you when you come in for your complimentary examination.

HOW LONG DOES THE LASIK OR PRK PROCEDURE TAKE?
The actual laser reshaping correction takes about 60 seconds or less for each eye, and your stay in the operating room will last about 30 minutes. However, you should plan on being at the laser center for about 2 hours to complete pre-and post-operative procedures and instructions.

WHAT IF I CAN’T KEEP MY EYE OPEN DURING THE PROCEDURE?
Dr. Talamo uses a small device (an eyelid speculum) that holds your eyelids open during the surgery. This procedure does not cause sharp pain, although you may feel pressure when it is placed against the eyelid.

WHAT IF I DON’T HOLD STILL?
Dr. Talamo is constantly monitoring your eye position and will stop the laser procedure instantly should you look away. (It is not very difficult to hold your eye still since there is no sensation of any kind.) However, if your eye should drift or waver slightly, an automated eye tracker allows the laser treatment to remains centered on your eye. If the eye moves too much, the tracker shuts off the laser automatically if the surgeon has not already done so.

HOW LONG BEFORE I CAN RETURN TO WORK?
Dr. Talamo recommends you take the day after surgery off, but some people return to work the very next day. Most patients have functional vision within the first 24-48 hours after the Lasik and Intacs procedures. After PRK, most patients take 3-4 days off before returning to work.

CAN I DRIVE IMMEDIATELY AFTER VISION CORRECTION?
On the day of your procedure, Dr. Talamo recommends you have someone with you to drive you home. However, most people can return to driving the next day. Most patients have functional vision within the first 24-48 hours after the Lasik and Intacs procedures.

WHAT IS AN ENHANCEMENT?
Every patient and surgeon wants to achieve perfect vision with one treatment. However, sometimes patients with a higher correction may require a further treatment. It is more difficult to accurately predict the outcome results at higher corrections than it is with a lower correction. In these types of cases it is not unusual to perform a second procedure after the first one is healed. The additional procedure is used to refine or improve the original visual results and is called an enhancement.

HOW LONG AFTER THE FIRST PROCEDURE WILL THE ENHANCEMENT TYPICALLY BE DONE?
That will depend on the type of refractive procedure. With LASIK and PRK, most surgeons wait 6 to 12 months. With Intacs, the waiting is significantly less. Your surgeon will advise the proper timeframe for your specific healing process.

IF I HAVE A LASIK ENHANCEMENT, WILL A NEW FLAP BE NECESSARY?
It is possible there will be a need to create a new flap, but in most cases enhancements are done by re-lifting the original flap or placing laser treatment right onto the surface of the flap (PRK).

HOW LONG AFTER REFRACTIVE PROCEDURES WILL IT TAKE BEFORE I HAVE BETTER VISION?
Clarity of vision will depend greatly on the procedure and your original refractive error. The skill and experience of your surgeon will play an important role in your specific outcome. Dr. Talamo has close to 20 years of experience and teaches other surgeons and optometrists.

LASIK: Within 6-24 hours. Typically, patients experience a 60% improvement immediately. This percentage continues to improve over the next several hours. In general, the smaller the refractive error, the better the chance of seeing 20/20 or better without correction.

PRK: May take several days for visual clarity with continued improvement over the next several weeks or months. For this reason, PRK treatments are often done on separate days.

Intacs: Recovery is faster that PRK, slower than LASIK.

IF I NEED TO, CAN I WEAR CONTACT LENSES AFTER LASER VISION CORRECTION?
The majority of patients do not need to wear contact lenses after surgery. In general, if patients were able to wear contact lenses comfortably prior to surgery, they will be able to wear them after surgery. The only caveat is that it will take time to get accustomed to wearing contact lenses again.

CAN I SCUBA DIVE OR HIKE TO HIGH ALTITUDES AFTER REFRACTIVE PROCEDURES?
Typically, yes. However, if you intend to participate in any extreme sports, please discuss with your surgeon how vision correction procedures may affect your particular situation.

CAN I GET A PILOT’S LICENSE IF I HAVE REFRACTIVE SURGERY?
Yes. You will need to have your surgeon complete some FAA forms and meet certain FAA vision requirements. If you fly commercially, you should get clearance from your employer.

WHAT IS CUSTOM LASER VISION CORRECTION?
Custom treatment refers to the use of information about the corneal shape light scattering properties of the eye to aid treatment. We obtain this information at the pre-operative testing visit and use it to create a software program that is fed into the laser to create a unique treatment for each individual eye. We use the CustomVue system from VISX, which is described in more detail below.

What is CustomVue™ individualized laser vision correction?
CustomVue procedures differ from traditional laser vision correction by using WaveScan® technology to measure the unique imperfections in your vision — 25 times more precisely than standard methods. This creates a "map" of your eye, which is as unique as your fingerprint. Your surgeon then transfers this precise data directly to a VISX® laser, and uses it to custom-tailor your individualized treatment.

Who is a candidate for the CustomVue procedure?
Treatments are available for a variety of patients, including those with astigmatism, whether the astigmatism is associated with nearsightedness, farsightedness or mixed astigmatism. As a result, more than 92 percent of the U.S. population that requires vision correction, 21 years of age or older, are eligible for this life-altering procedure. If you are 21 years of age or older and wear glasses or contacts to correct nearsightedness, farsightedness and/or astigmatism, you may benefit from the CustomVue procedure. If you meet the criteria, you should see your eye doctor for more information.

What is WaveScan technology?
WaveScan technology was originally developed for use in high-powered telescopes to reduce distortions when viewing distant objects in space. This technology has now been applied to laser vision correction, measuring imperfections in the eye never before measured using standard methods for glasses and contact lenses. WaveScan-based digital technology identifies and measures imperfections in an individual’s eye 25 times more precisely than standard methods. Physicians use this information to treat individuals with the CustomVue procedure.

Why is WaveScan technology so important to the CustomVue procedure?
Until now, physicians were forced to practice one-size-fits-all vision. An off-the-shelf lens corrects an individual's vision fairly well, but it is not uniquely tailored to "The Fingerprint of Your Vision®." Now, with WaveScan technology, we can custom tailor a correction for the unique characteristics of each individual's vision.

What is Iris Registration Technology?
It's the first fully automated method of aligning and registering wavefront corrections for CustomVue treatments. It's normal for the pupil to shift positions from the point of wavefront measurement to the point of treatment. Iris Registration Technology centers the treatment correctly, independent of changes in the pupil center from measurement to treatment.

Will I need glasses or contacts after the CustomVue procedure?
Probably not. One year after an FDA clinical study for treatment of myopia (nearsightedness), all participants saw well enough to drive a car without glasses or contacts. Ninety-eight percent had 20/20 vision or better. However, individual results may vary.

What were the visual acuity results of that FDA clinical study for myopia?
A significant result was that one year after the VISX CustomVue™ procedure

• 100% of participants could pass a driving test without glasses or contacts
  
• 98% of participants could see 20/20 or better without glasses or contacts
• 70% of participants could see better than 20/20 without glasses or contacts

What does "better than 20/20" mean?
20/20 is the current standard for excellence in vision. But, with the CustomVue procedure, individuals have the potential to see even better than 20/20.

How could the CustomVue procedure affect my night vision?
In FDA clinical studies for the treatment of myopia (nearsightedness) and hyperopia (farsightedness), four times as many participants were very satisfied with their night vision after the procedure, as compared with their night vision before with glasses or contacts. In an FDA clinical study for treatment of mixed astigmatism, twice as many participants were very satisfied with their night vision after the procedure, as compared with their night vision before with glasses or contacts.

TELL ME MORE ABOUT VISX S4.
The Visx S4 is our laser of choice, and is approved for a wider range of indications than any of the six FDA approved lasers in the United States. It has an aspirator to remove the vaporized corneal tissue so that it does not fall back onto the corneal surface. It has seven scanning beams and a sophisticated eye-tracking system. Visx laser systems are calibrated multiple times throughout each surgical day, and calibration test results analyzed by the surgeon and the technical staff prior to your surgery.

HOW LONG HAVE PRK AND LASIK BEEN APPROVED BY THE FDA?
PRK and LASIK are surgical procedures and therefore do not requires FDA approval (only devices do). However, the FDA has approved the use of many excimer lasers for PRK and LASIK to treat a variety of refractive errors.

HOW LONG HAS THE EXCIMER LASER BEEN APPROVED BY THE FDA?
The excimer laser had been available outside the United States for eight years before the U.S. approved it for use in this country. The first nearsighted patient’s eye ever treated with laser vision correction in the United States was in 1987.

The first excimer laser was approved by The US Food and Drug Administration in October, 1995 for the treatment of mild to moderate nearsightedness (-1.5 to 7.0 diopters with astigmatism no greater than 1.5 diopters) in persons 21 or older. The FDA approved the excimer laser to correct astigmatism in April, 1997 and farsightedness in November, 1998.

WHEN WAS THE VISX LASER APPROVED BY THE FDA?
The FDA approved the Visx Laser in March of 1996. Since that time, the laser has undergone many software and hardware upgrades.

IF REFRACTIVE PROCEDURES ARE MORE ADVANCED OUTSIDE THE U.S., SHOULDN’T I WAIT OR TRAVEL ABROAD?
It is true that some lasers outside the U.S. have expanded programming capabilities and techniques not approved in the U.S. However, most available techniques in the U.S. produce excellent results for most people, with the additional safety benefits that accrue from careful prior scrutiny of the technology by the FDA. If upon examination, your eyes present no particular problems, the U.S. technology should give you excellent results also.

WHICH LASER IS THE BEST?
Each laser company claims their laser is the best. The best equipment in the world will not compensate for an unskilled surgeon. However, most surgeons have very definite preferences. If you choose the best surgeon and then let that surgeon choose his/her equipment, you will have the highest probability for your best visual outcome.

WHAT DOES OFF-LABEL USE MEAN?
Some but not too many variations of the LASIK procedure are considered an “off-label” use of the FDA approved excimer laser. The FDA does not evaluate surgical procedures that

do not require a new medical device. The best way to explain ”off-label,” is by using another example. The FDA approved aspirin for headaches when it was first approved for sale in the U.S. However, aspirin is widely prescribed and successfully used to treat high blood pressure. That would be an “off-label” use for aspirin.

WHAT ARE INTACS?
Intacs are microscopic prescription inserts placed within the outer portion of the cornea to correct low to moderate amounts of nearsightedness (up to -3 Diopters). Intacs do not correct for astigmatism, so if you have more than 0.5 D of astigmatism, laser may be better.

SOME ADVANTAGES TO INTACS:

• Are removable to exchange for a different size if your vision changes.
• Their insertion is usually reversible, as Intacs can be removed and the cornea returns to its approximate original shape. Vision typically returns to what it was prior to the procedure.
• Intacs are placed outside of the central optical zone, which is the critical area for clear vision.

HOW DO INTACS WORK?
Intacs slightly reshape the cornea so that the light rays will be properly focused on the back of the eye (the retina) thereby improving visual acuity.

WHAT CONDITION DOES INTACS CORRECT?
Nearsightedness (myopia) only, and also in some cases of keratoconus, Intacs are used to improve contact lens fit.

WHAT RANGE OF REFRACTIVE ERROR DOES INTACS CORRECT?
Mild to moderate myopia = minus one (-1.00) to minus three (-3.00)

WHAT IS THE VISIAN LENS OR PHAKIC IOL OR ICL?
A lens placed inside the eye in order to treat extreme nearsightedness or farsightedness. These procedures are FDA approved, and Dr. Talamo has been performing phakic IOL procedures for close to 2 years now. The best candidates are severely nearsighted, and you may be a candidate for a phakic IOL even if you have been previously told that you were not a candidate for laser vision correction.

WHAT IS RK?
Radial Keratotomy, or RK is a surgical procedure to correct myopia in which a calculated number of incisions are made by the periphery of the cornea to allow the central cornea to flatten. The incisions are made in a spoke-like fashion radiating from the cornea. Flattening the cornea reduces the cornea’s optical power and allows light and images to focus on the retina. This procedure is rarely performed now.

HOW LONG HAS RK BEEN APPROVED BY THE FDA?
RK has been available since the 1950’s in Japan and since 1979 in the United States.

WHAT IS THE RANGE OF CORRECTION FOR RK?
RK is most effective on patients with low to moderate myopia who require up to –5.00 diopters of correction. PRK, Intacs and Lasik have replaced RK for the vast majority of Patients.

WHAT IS AK?
Astigmatic Keratotomy (AK) was the earliest form of corneal refractive surgery. It treats astigmatism, as the name suggests. AK is similar to RK in that it is incisional surgery, but the calculated surgical incisions are made tangentially across the cornea, are shorter, and stay farther away from the visually important central cornea than RK incisions.

Note: This document was compiled and edited by our team and surgeon using reliable sources of information. Its intent is to answer most frequently asked questions over several years of refractive surgical practice. If you have additional concerns, please be sure to communicate them to a member of the team or to your surgeon.
Version 2005 revised by JHT and CBC